Topic Contents

Fever or Chills, Age 11 and Younger

Topic Overview

Fever is the body's normal and healthy reaction to infection and other illnesses, both minor and serious. Fevers help the body fight infection. Fever is a symptom, not a disease. In most cases, fever means your child has a minor illness. Often you must look at your child's other symptoms to determine how serious the illness is. Although it may be scary when your child's temperature goes up, fever is not harmful.

Normal body temperature

The average normal body temperature is about 37°C (98.6°F). It usually rises during the day from a low of 36.5°C (97.7°F) in the morning to a high of 37.5°C (99.5°F) in the late afternoon. Each child has a normal temperature range that may be different from another child's. Mild increases to 38°C (100.4°F) can be caused by exercising, wearing too many clothes, taking a hot bath, or being outside in hot weather.

Fever

Temperature varies depending on how you take it. The most common methods to measure it are:

Some methods may not be as reliable or accurate as others. For information about taking accurate temperatures, see the topic Body Temperature.

If you think your child has a fever but you are not able to measure his or her temperature, it is important to look for other symptoms of illness.

Children tend to run higher fevers than adults. The degree of fever may not indicate how serious your child's illness is. With a minor illness, such as a cold, a child may have a temperature of 40°C (104°F), while a very serious infection may not cause a fever or may cause only a mild fever. With many illnesses, a fever temperature can go up and down very quickly and often, so be sure to look for other symptoms along with the fever.

Babies with a fever often have an infection caused by a virus, such as a cold or the flu. Infections caused by bacteria, such as a urinary infection or bacterial pneumonia, also can cause a fever. Babies younger than 3 months should be seen by a doctor anytime they have a fever because they can get extremely sick quickly.

A fever in a healthy child is usually not dangerous, especially if the child does not have other symptoms and the fever goes away in 3 to 4 days. Most children who have a fever will be fussy and play less and may not eat as much as usual.

High fevers may make your child uncomfortable, but they rarely cause serious problems. There is no medical evidence that fevers from infection cause brain damage. The body limits a fever caused by infection from rising above 41°C (106°F). But outside heat-such as from being in a car that is parked in the sun-can cause body temperature to rise above 41.7°C (107°F), and brain damage can occur.

Childhood immunizations can reduce the risk for fever-related illnesses, such as Haemophilus influenzae type b (Hib) infection. Although no vaccine is 100% effective, most routine childhood immunizations are effective for 85% to 95% of the children who receive them. For more information, see the topic Immunizations.

Causes of fever

It is not unusual for a preschool-aged child to have 7 to 10 viral infections in a year. Each new viral infection may cause a fever. It may seem that a fever is ongoing, but if 48 hours pass between fevers, then the new fever is most likely from a new illness.

Teething may cause a mild increase in your child's temperature. But if the temperature is higher than 38°C (100.4°F), look for symptoms that may be related to an infection or illness.

A fever that increases quickly may lead to a fever seizure in some children. After a fever has reached a high temperature, the risk of a seizure is less. Fever seizures can be frightening to see, but they usually do not cause other problems, such as brain damage, intellectual disability, or learning problems. If your child has a high fever and a seizure, see the topic Fever Seizures.

Low body temperature

An abnormally low body temperature (hypothermia) can be serious, even life-threatening. Low body temperature may occur from cold exposure, shock, alcohol or drug use, or certain metabolic disorders, such as diabetes or hypothyroidism. A low body temperature may also be present with an infection, particularly in newborns, older adults, or people who are frail. An overwhelming infection, such as sepsis, may also cause an abnormally low body temperature.

This is the only way to be sure that a baby this age does not have a fever. If you don't know the temperature, it's safest to assume the baby has a fever and needs to be seen by a doctor. Any problem that causes a fever at this age could be serious. Rectal temperatures are the most accurate. Taking an axillary (armpit) temperature is also an option.

Yes

Temperature taken

No

Temperature taken

Is it 38°C (100.4°F) or higher, taken rectally?

This would be an axillary temperature of 37.3°C (99.1°F) or higher.

Yes

Temperature at least 38°C (100.4°F) taken rectally

No

Temperature at least 38°C (100.4°F) taken rectally

Has your child had an immunization (vaccine) within the past 24 hours?

It's common for children to have a mild to moderate fever after getting immunized.

Symptoms of difficulty breathing can range from mild to severe. For example:

You may feel a little out of breath but still be able to talk (mild difficulty breathing), or you may be so out of breath that you cannot talk at all (severe difficulty breathing).

It may be getting hard to breathe with activity (mild difficulty breathing), or you may have to work very hard to breathe even when you’re at rest (severe difficulty breathing).

Symptoms of difficulty breathing in a baby or young child can range from mild to severe. For example:

The child may be breathing a little faster than usual (mild difficulty breathing), or the child may be having so much trouble that the nostrils are flaring and the belly is moving in and out with every breath (severe difficulty breathing).

The child may seem a little out of breath but is still able to eat or talk (mild difficulty breathing), or the child may be breathing so hard that he or she cannot eat or talk (severe difficulty breathing).

Sudden drooling and trouble swallowing can be signs of a serious problem called epiglottitis. This problem can happen at any age.

The epiglottis is a flap of tissue at the back of the throat that you can't see when you look in the mouth. When you swallow, it closes to keep food and fluids out of the tube (trachea) that leads to the lungs. If the epiglottis becomes inflamed or infected, it can swell and quickly block the airway. This makes it very hard to breathe.

The symptoms start suddenly. A person with epiglottitis is likely to seem very sick, have a fever, drool, and have trouble breathing, swallowing, and making sounds. In the case of a child, you may notice the child trying to sit up and lean forward with his or her jaw forward, because it's easier to breathe in this position.

If you're not sure if a child's fever is high, moderate, or mild, think about these issues:

With a high fever:

The child feels very hot.

It is likely one of the highest fevers the child has ever had.

With a moderate fever:

The child feels warm or hot.

You are sure the child has a fever.

With a mild fever:

The child may feel a little warm.

You think the child might have a fever, but you're not sure.

Severe dehydration means:

The baby may be very sleepy and hard to wake up.

The baby may have a very dry mouth and very dry eyes (no tears).

The baby may have no wet diapers in 12 or more hours.

Moderate dehydration means:

The baby may have no wet diapers in 6 hours.

The baby may have a dry mouth and dry eyes (fewer tears than usual).

Mild dehydration means:

The baby may pass a little less urine than usual.

Severe dehydration means:

The child's mouth and eyes may be extremely dry.

The child may pass little or no urine for 12 or more hours.

The child may not seem alert or able to think clearly.

The child may be too weak or dizzy to stand.

The child may pass out.

Moderate dehydration means:

The child may be a lot more thirsty than usual.

The child's mouth and eyes may be drier than usual.

The child may pass little or no urine for 8 or more hours.

The child may feel dizzy when he or she stands or sits up.

Mild dehydration means:

The child may be more thirsty than usual.

The child may pass less urine than usual.

You can use a small rubber bulb (called an aspirating bulb) to remove mucus from your baby's nose or mouth when a cold or allergies make it hard for the baby to eat, sleep, or breathe.

To use the bulb:

Put a few saline nose drops in each side of the baby's nose before you start.

Position the baby with his or her head tilted slightly back.

Squeeze the round base of the bulb.

Gently insert the tip of the bulb tightly inside the baby's nose.

Release the bulb to remove (suction) mucus from the nose.

Don't do this more than 5 or 6 times a day. Doing it too often can make the congestion worse and can also cause the lining of the nose to swell or bleed.

Severe trouble breathing means:

The child cannot eat or talk because he or she is breathing so hard.

The child's nostrils are flaring and the belly is moving in and out with every breath.

The child seems to be tiring out.

The child seems very sleepy or confused.

Moderate trouble breathing means:

The child is breathing a lot faster than usual.

The child has to take breaks from eating or talking to breathe.

The nostrils flare or the belly moves in and out at times when the child breathes.

Mild trouble breathing means:

The child is breathing a little faster than usual.

The child seems a little out of breath but can still eat or talk.

Symptoms of heatstroke may include:

Feeling or acting very confused, restless, or anxious.

Trouble breathing.

Sweating heavily, or not sweating at all (sweating may have stopped).

Skin that is red, hot, and dry, even in the armpits.

Passing out.

Seizure.

Nausea and vomiting.

Heatstroke occurs when the body can't control its own temperature and body temperature continues to rise.

Pain in children under 3 years

It can be hard to tell how much pain a baby or toddler is in.

Severe pain (8 to 10): The pain is so bad that the baby cannot sleep, cannot get comfortable, and cries constantly no matter what you do. The baby may kick, make fists, or grimace.

Moderate pain (5 to 7): The baby is very fussy, clings to you a lot, and may have trouble sleeping but responds when you try to comfort him or her.

Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds when you try to comfort him or her.

Pain in children 3 years and older

Severe pain (8 to 10): The pain is so bad that the child can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain. No one can tolerate severe pain for more than a few hours.

Moderate pain (5 to 7): The pain is bad enough to disrupt the child's normal activities and sleep, but the child can tolerate it for hours or days.

Mild pain (1 to 4): The child notices and may complain of the pain, but it is not bad enough to disrupt his or her sleep or activities.

Sudden tiny red or purple spots or sudden bruising may be early symptoms of a serious illness or bleeding problem. There are two types.

Petechiae (say "puh-TEE-kee-eye"):

Are tiny, flat red or purple spots in the skin or the lining of the mouth.

Do not turn white when you press on them.

Range from the size of a pinpoint to the size of a small pea and do not itch or cause pain.

May spread over a large area of the body within a few hours.

Are different than tiny, flat red spots or birthmarks that are present all the time.

Purpura (say "PURR-pyuh-ruh" or “PURR-puh-ruh”):

Is sudden, severe bruising that occurs for no clear reason.

May be in one area or all over.

Is different than the bruising that happens after you bump into something.

Symptoms of serious illness in a baby may include the following:

The baby is limp and floppy like a rag doll.

The baby doesn't respond at all to being held, touched, or talked to.

The baby is hard to wake up.

Symptoms of serious illness may include:

A severe headache.

A stiff neck.

Mental changes, such as feeling confused or much less alert.

Extreme fatigue (to the point where it's hard for you to function).

Shaking chills.

Shock is a life-threatening condition that may occur quickly after a sudden illness or injury.

Symptoms of shock in a child may include:

Passing out (losing consciousness).

Being very sleepy or hard to wake up.

Not responding when being touched or talked to.

Breathing much faster than usual.

Acting confused. The child may not know where he or she is.

Fever can be a symptom of almost any type of infection. Symptoms of a more serious infection may include the following:

Skin infection: Pain, redness, or pus

Joint infection: Severe pain, redness, or warmth in or around a joint

Bladder infection: Burning when you urinate, and a frequent need to urinate without being able to pass much urine

Kidney infection: Pain in the flank, which is either side of the back just below the rib cage

Abdominal infection: Belly pain

Many prescription and non-prescription medicines can trigger an allergic reaction and cause a fever. A few examples are:

Antibiotics.

Barbiturates, such as phenobarbital.

ASA, if you take too much.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

Call your doctor today to discuss the symptoms and arrange for care.

If you cannot reach your doctor or you don't have one, seek care today.

Home Treatment

It can be hard to know whether you should call your doctor when your child has a fever, especially during the cold and flu season. The degree of the fever may not be related to the seriousness of the illness. The way your child looks and acts is a better guide than the thermometer. Most children will be less active when they have a fever.

If your child is comfortable and alert, is eating well, is drinking enough fluids, is urinating normal amounts, and seems to be improving, home treatment without medicine is all that is needed for a fever. Dress your child lightly, and do not wrap him or her in blankets. Dressing lightly will help your child's body cool down.

Try these home treatment measures to make sure your child is drinking enough fluids and does not get dehydrated while he or she has a fever.

Newborns and babies younger than 1 year of age

Don't wait until you see signs of dehydration in your baby. These signs include your baby being thirstier than usual and having less urine than usual.

If you breastfeed your baby, nurse him or her more often. Offer each breast to your baby for 1 to 2 minutes every 10 minutes.

If you use a bottle to feed your baby, increase the number of feedings to make up for lost fluids. The amount of extra fluid your baby needs depends on your baby's age and size. For example, a newborn may need as little as 1 fl oz (30 mL) at each extra feeding, while a 12-month-old baby may need as much as 3 fl oz (90 mL) at each extra feeding.

Ask your doctor if you need to use an oral rehydration solution (ORS) if your baby still isn't getting enough fluids from formula or the breast. The amount of ORS your baby needs depends on your baby's age and size. You can give the ORS in a dropper, spoon, or bottle.

If your baby has started eating cereal, you may replace lost fluids with cereal. You also may feed your baby strained bananas and mashed potatoes if your child has had these foods before.

Children ages 1 through 11

Make sure your child is drinking often. Frequent, small amounts work best.

Allow your child to drink as much fluid as he or she wants. Encourage your child to drink extra fluids or suck on flavoured ice pops, such as Popsicles. Note: Do not give your child fruit juice or soda pop. Fruit juice and soda pop contain too much sugar and not enough of the essential minerals (electrolytes) that are being lost. Diet soda pop lacks calories that your child needs.

Cereal mixed with milk or water may also be used to replace lost fluids.

If your child still is not getting enough fluids, you can try an oral rehydration solution (ORS).

Keep your child comfortable

Lowering your child's temperature is important when the fever is causing discomfort. If your child is uncomfortable:

Medicine you can buy without a prescription

Try a non-prescription medicine to help treat your child's fever or pain:

Talk to your child's doctor before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine.

Safety tips

Be sure to follow these safety tips when you use a non-prescription medicine:

Carefully read and follow all labels on the medicine bottle and box.

Give, but do not exceed, the maximum recommended doses.

Do not give your child a medicine if he or she has had an allergic reaction to it in the past.

Symptoms to watch for during home treatment

Your child has signs of dehydration and is not able to drink enough to replace lost fluids. Signs of dehydration include being thirstier than usual and having darker urine than usual.

Other symptoms develop, such as pain in one area of the body, shortness of breath, or urinary symptoms.

Symptoms become more severe or frequent.

Prevention

The best way to prevent fevers is to reduce your child's exposure to infectious diseases. Handwashing is the single most important prevention measure for people of all ages.

Childhood immunizations can reduce the risk for fever-related illnesses, such as Haemophilus influenzae type b (Hib) infection. Although no vaccine is 100% effective, most routine childhood immunizations are effective for 85% to 95% of the children who receive them. For more information, see the topic Immunizations.

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